Renal and intraglomerular haemodynamics in chronic heart failure with preserved and reduced ejection fraction

Abstract

Aims: Congestive heart failure (CHF) and impaired renal function are two often co-existing medical conditions and associated with adverse cardiovascular outcome. The aim of the current study was to assess renal and intraglomerular haemodynamics by constant infusion input clearance technique in subjects with CHF.

Methods and results: The group of subjects with CHF consisted of 27 individuals with HFpEF and 27 individuals with HFrEF and were compared with 31 healthy controls. Subjects underwent renal clearance examination to measure glomerular filtration rate (GFR) and renal blood and plasma flow (RBF and RPF) and to calculate intraglomerular haemodynamics such as resistances of the afferent (R_A ) and efferent arterioles (R_E ) as well as intraglomerular pressure (P_glom ). Measured GFR was lower in CHF subjects (68.1 ± 10.1 mL/min/1.73 m² ) compared with controls (83.6 ± 13.4 mL/min/1.73 m² , P_adj < 0.001) as was P_glom (P_adj < 0.001). Total renal vascular resistance (RVR) was higher in CHF subjects (87.3 ± 20.1 vs. 73.8 ± 17.1 dyn × s/cm⁵ , P_adj < 0.001) mediated by an increased resistance at the afferent site (3201 ± 1084 vs. 2181 ± 796 dyn × s/cm⁵ , P_adj < 0.001). Comparing HFpEF and HFrEF subjects, R_A was higher in HFrEF subjects. The severity of CHF assessed by NT-proBNP revealed an inverse association with renal perfusion (RPF r = -0.421, P = 0.002, RBF r = -0.414, P = 0.002) and a positive relation with RVR (r = 0.346, P = 0.012) at the post-glomerular site (R_E : r = 0.318, P = 0.022).

Conclusions: Renal function assessed by measured GFR is reduced and renal vascular resistance at the preglomerular, afferent site is increased in HFpEF and, to greater extent, in HFrEF. Our data indicate a close cardiorenal interaction in CHF.

Trial registration: ClinicalTrials.gov NCT03672591.

Keywords: Cardiorenal interaction; Heart failure; Preserved ejection fraction; Reduced ejection fraction; Renal haemodynamics.

Figure 1

Renal clearance examination protocol.

Figure 2

Correlation between NT‐proBNP and renal parameters. CHF, chronic heart failure; RBF, renal blood flow; R_E, resistance of the efferent arteriole; RPF, renal plasma flow; RVR, renal vascular resistance.